Ross Naylor

University Hospitals Of Leicester NHS Trust | UHL · Leicester Vascular Institute

The best way to escape from a problem is to solve it. dAlan Saporta The management of carotid artery disease has been guided by the largest evidence base (relative to other vascular territories), comprising 4 randomized controlled trials (RCTs) comparing carotid endarterectomy (CEA) with best medical therapy (BMT) in symptomatic and asymptomatic pa...

Introduction The 2017 European Society for Vascular Surgery (ESVS) guidelines on carotid and vertebral artery disease concluded that the evidence did not support a role for carotid endarterectomy (CEA) or carotid artery stenting (CAS) in patients with asymptomatic carotid stenosis (ACS) in preventing cognitive impairment or dementia. What new data...

Objective The aim was to enhance understanding of the role of platelet biomarkers in the pathogenesis of vascular events and risk stratifying patients with asymptomatic or symptomatic atherosclerotic carotid stenosis. Data Sources Systematic review conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses...

Objective This review aimed to analyse the timing of carotid endarterectomy (CEA) and carotid artery stenting (CAS) after the index event as well as 30 day outcomes at varying time periods within 14 days of symptom onset. Methods A systematic review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-analysis s...

Objective To determine the effect of carotid endarterectomy (CEA) and carotid artery stenting (CAS) on early (baseline vs. maximum three months) and late (baseline vs. at least five months) cognitive function in patients with exclusively asymptomatic carotid stenoses (ACS). Method Searches were conducted in PubMed/Medline, Embase, Scopus, and the...

Current guidelines for primary and secondary prevention of stroke in patients with carotid atherosclerosis are based on the quantification of the degree of stenosis and symptom status. Recent publications have demonstrated that plaque morphology and composition, independent of the degree of stenosis, are important in the risk stratification of caro...

Objective To evaluate the safety of carotid artery stenting (CAS) and carotid endarterectomy (CEA) after thrombolytic therapy (TT). Data sources Medline, Scopus, and Cochrane databases. Review Methods Systematic review and meta-analysis of studies involving patients who underwent CEA/CAS after TT. Results In 25 studies (n = 147 810 patients), 2...

Objective No dedicated studies have been performed on the optimal management of patients with an acute stroke related to carotid intervention nor is there a solid recommendation given in the European Society for Vascular Surgery guideline. By implementation of an international expert Delphi panel, this study aimed to obtain expert consensus on the...

Objective The aim of this study was to evaluate the effect of pre-operative intravenous thrombolytic therapy (ivTT) on short term outcomes after carotid endarterectomy (CEA) among patients who presented with ischaemic stroke. Methods A retrospective study using a large population based dataset from the National Vascular Registry in the United King...

Objective The aim was to evaluate the relationship between asymptomatic carotid stenosis (ACS) of any severity and cognitive impairment and to determine whether there is evidence supporting an aetiological role for ACS in the pathophysiology of cognitive impairment. Data sources PubMed/Medline, Embase, Scopus, and the Cochrane library. Review met...

Objective: To establish 30 day and mid term outcomes in patients treated for significant stenoses affecting the proximal common carotid artery (CCA) or innominate artery (IA) with/without tandem disease of the ipsilateral internal carotid artery (ICA). Methods: Systematic review of early and mid term outcomes in 1 969 patients from 77 studies (1...

Transcarotid revascularization is an alternative to transfemoral carotid artery stenting, designed to avoid aortic arch manipulation and concomitant periprocedural stroke. This article aims to perform a detailed analysis on the quality of the currently available evidence on safety and efficacy of transcarotid artery revascularization. Although curr...

Peripheral arterial diseases comprise different clinical presentations, from cerebrovascular disease down to lower extremity artery disease, from subclinical to disabling symptoms and events. According to clinical presentation, the patient's general condition, anatomical location and extension of lesions, revascularisation may be needed in addition...

The authors regret that the name of one of the co-author has been incorrectly spelt. Dr. Melina Vega de Ceniga should have been cited as “Vega de Ceniga M” The authors would like to apologise for any inconvenience caused.

Peripheral arterial diseases comprise different clinical presentations, from cerebrovascular disease down to lower extremity artery disease, from subclinical to disabling symptoms and events. According to clinical presentation, the patient's general condition, anatomical location and extension of lesions, revascularisation may be needed in addition...

Objectives: The aim of this review was to carry out primary and secondary analyses of 20 randomised controlled trials (RCTs) comparing carotid endarterectomy (CEA) with carotid artery stenting (CAS). Methods: A systematic review and meta-analysis of data from 20 RCTs (126 publications) was carried out. Results: Compared with CEA, the 30 day de...

Background and Purpose— Carotid endarterectomy (CEA) reduces the risk of stroke in recently symptomatic patients and less so in asymptomatic patients. Recent evidence suggests that the number of CEAs may be declining. The aim of this study was to investigate annual patterns of CEA in asymptomatic and symptomatic patients in England from 2011 to 201...

Background: The complications discussed with patients by surgeons prior to surgery vary, because no consensus on major complications exists. Such consensus may improve informed consent and shared decision-making. This study aimed to achieve consensus among vascular surgeons on which complications are considered 'major' and which 'minor,' following...

Objectives: The aim was to determine the mode of presentation and 30 day procedural risks in 4418 patients with 4743 carotid body tumours (CBTs) undergoing surgical excision. Methods: This is a systematic review and meta-analysis of 104 observational studies. Results: Overall, 4418 patients with 4743 CBTs were identified. The mean age was 47 y...

OBJECTIVE The authors sought to investigate the incidence and predictors of venous thromboembolic events (VTEs) after craniotomy for tumor resection, which are not well established, and the efficacy of and risks associated with VTE chemoprophylaxis, which remains controversial.METHODS The authors investigated the incidence of VTEs in a consecutive...

This article describes the ESVS practice guidelines for abdominal aortic and iliac aneurysms.

Objectives: Carotid stenosis patients are at risk of vascular events despite antiplatelet therapy. Data on prescribed antiplatelet regimens have not been comprehensively collated from trials to guide optimal therapy in this population. Methods: This review was conducted in line with the current Preferred Reporting Items for Systematic Reviews an...

The most common single cause of ischaemic carotid territory stroke is thromboembolism from stenoses in the extracranial internal carotid artery (ICA). In the majority, embolism is preceded by an acute change in plaque morphology predisposing the patient to overlying thrombus formation and embolization. The management of patients with carotid artery...

We would agree that the rate of type Ib endoleaks of 1.6% in the registry seems low, and may be underdiag-nosed. Persistent false lumen perfusion through distal reentry tears can lead to aneurysmal growth and treatment failure. There is clearly a role for adjunctive false lumen embolization, as stated by Pellenc, and we have had clinical success us...

Background: The risk of stroke associated with carotid artery restenosis after stenting or endarterectomy is unclear. We aimed to compare the long-term risk of restenosis after these treatments and to investigate if restenosis causes stroke in a secondary analysis of the International Carotid Stenting Study (ICSS). Methods: ICSS is a parallel-gr...

The European Society for Vascular Surgery (ESVS) has recently prepared updated guidelines for the management of patients with symptomatic and asymptomatic atherosclerotic carotid artery disease, with specific reference to the roles of best medical therapy, carotid endarterectomy (CEA) and carotid artery stenting (CAS). In symptomatic patients, ther...

Introduction: A 2011 meta-analysis comparing eversion (eCEA) with conventional (cCEA) carotid endarterectomy in 16,251 patients concluded that eCEA was associated with lower rates of peri-operative stroke and late occlusion compared with cCEA. However, randomised controlled trials (RCTs) showed no difference in outcomes. Since then, the literature...

Background Physical motion throughout the cardiac cycle may contribute to the rupture of the atherosclerotic carotid plaque, resulting in ischaemic stroke. The purpose of this study was to quantify the physiological motion of the atherosclerotic carotid plaque and to investigate any relationship between the quantified motion parameters and the degr...

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In the 2012 VASCUNET report, 92 % of carotid interventions complied with European Society of Vascular Surgery carotid guidelines. Attitudes to treating asymptomatic patients varied considerably with the highest rates being observed in Italy (69 % of all CEA procedures), while Denmark did not offer CEA to any asymptomatic individuals. The UK had the...

Objective/background: The first paper in this series observed that pre-operative baroreceptor dysfunction and poorly controlled hypertension were independently predictive for identifying patients who went on to require treatment for post-endarterectomy hypertension (PEH). The second paper examines the influence of intra-operative patient, transcra...

These guidelines are dedicated to Paola De Rango, University of Perugia, Italy. She participated very actively in the process of developing these guidelines, in particular the important chapters on chronic arterial and venous mesenteric ischaemia. Six days after the second meeting of the task force she died unexpectedly, to our great despair and lo...

There is a paucity of high quality evidence regarding what constitutes ‘optimal medical therapy’ for the purposes of reducing morbidity/mortality following carotid endarterectomy (CEA). All patients should be prescribed antiplatelet therapy. Low dose aspirin (75-325mg) should be continued throughout the peri-operative period and there is no evidenc...